Building Health Reform’s Research Arm

PCORI is not quite a household name, but if Dr. Anne Beal has her way, it will be soon. The acronym stands for Patient Centered Outcomes Research Institute—a group of doctors, researchers, statisticians and patient advocates who will commission evidence-based research for the health care system. The goal, according to Beal, is to provide easy-to-understand information to patients so they can make the most informed health care decisions.

The quasi-governmental institute is partially funded through a $1-per-enrollee fee on certain insurers; the fee increases to $2 per person in 2013. It is enforced by the I.R.S. The new organization and its financing drew an attack this week from the Senate Republican Policy Committee. According to the committee’s blog, this fee “represents a complete turnaround from an Administration that campaigned against taxing health benefits.”

Beal

But Beal defends the levy, saying it would “help people decide what’s best for them in getting their desired health outcome.” She said more progressive insurers see this fee as an investment into PCORI’s mission. “[Insurers] are interested in paying for the right care at the right time for the right patient–it’s not just about writing a check, but it’s also about making sure people get the best they can out of the health care system.”

Beal, the No. 2 at the new institute under Executive Director Joe Selby, comes to PCORI after leading the Aetna Foundation, the philanthropic arm of Aetna Inc. There, she emphasized three areas: preventing obesity, racial and ethnic health care equity, and integrated care. Beal says she’ll carry that experience into her new role: “Health equity is going to be one of the priority areas within [PCORI’s] research agenda.”

In December, 856 project proposals flooded the PCORI office vying for funds. By March, the burgeoning staff at PCORI will have picked approximately 40 projects to fund with $26 million in grants over two years. Those will help set the tone for PCORI’s standards of research.

Listen to Beal discuss PCORI

Reporter Shefali S. Kulkarni talks with Anne Beal about what PCORI is and what it’ll do:

But the organization is so new that Beal, who began her work there in November, said the projects are just one part of getting the institute rolling.

“They say being in a startup is like driving a train while you are building the tracks. Well we’re forging the steel and building the tracks and driving the train,” she said.

KHN’s Shefali S. Kulkarni spoke with Beal about building those tracks for the future of the new agency. Edited excerpts follow.

Q: Can you give an example of how you envision people using the kind of research that PCORI will fund?

A: Let’s say someone is trying to decide if they should have Procedure A versus Procedure B. You give them all this information, but what the patient is saying is, “Well, what’s really important for me is that I’m very afraid of pain. What procedure is going to be the lowest pain option that still gives me the benefits that I need?” Somebody else is going to be very interested in what will give them the longest life. Somebody else may say, “Well, what’s really important to me is whatever procedures I have, I am a working parent and I can’t really afford a lot of time off from work, so what procedure is really going to take care of this condition, but get me back to work as quickly as I can?”

So, then we [at PCORI] are trying to think of the different options that are available to us, not only looking at research that says, “If you do this cardiac procedure versus this cardiac procedure, here’s what the outcome is.” But now: here’s what the outcome is in terms of pain, here’s what the outcome is in terms of days off from work, here’s what the outcome is in terms of longevity. So then you, as the patient, have the information to make that comparison and make really a tailored decision that meets your needs.

Q: Where does PCORI fit into the health care law?

A: What PCORI is trying to do is address where some people said health reform fell short — so you have access, but access to what? Now that we [will] have, as a result of the Affordable Care Act, near universal access to health care, we need to really turn our attention to make sure the health care system is really meeting the needs of every patient. And in some ways that is a very grand view, but I think it’s quite necessary to really take this sort of vision of what health care should be, but then make it mean something to the average patient.

Q: Can you give an example of that?

A: Well, from a personal perspective, in the last few years my father’s been sick. So I come to Washington, I have these conversations…and we have these sort of very grand ideas of what health care should be. Then I go home and I’m at my father’s bedside, and I see the reality of what health care is. Because of all this, I think the patient experience is often fragmented and not well coordinated. There is a lot of ambiguity in health care, both on the part of providers and patients, therefore patients don’t necessarily know what the best choices available to them are. When really thinking about a patient-centered research enterprise, we have to think about if we present information that is a trusted source that people can go to and that really addresses their needs and concerns. [It should be] information and knowledge that was created from the patients’ perspective. For me, the promise of PCORI is really taking these highfalutin conversations and making them real, so that at the end of the day — you know next Thanksgiving, when I’m telling my family I work for PCORI — they know what that means.

Q: What will the organizational structure of PCORI be?

A: We take it very seriously when we say that the patient has to be engaged at every step of the process. So, for example, we have patient representation on our board — every grant review that we are going to have is going to have at least three patient representatives to make sure that not only is [the proposal] an interesting question, but is it a meaningful question to the patient? Even as we’re defining patient-centered outcomes research, we are engaging focus groups all around the country. Even as we are developing our research agenda, we’re looking for patient input. I think that is something that is really going to become part of our DNA, and we’re already seeing it manifest right now.

Q: Health disparities, obesity and health care delivery systems were your main focus at your last job as the president of the Aetna Foundation. How is PCORI going to address these issues?

A: A lot of what drives health disparities is in fact differences in health systems’ function. I think one of the most exciting promises of PCORI is that included in our thinking about comparative effectiveness is that we want to compare systems of care. So being able to look at the role of the health system in achieving high quality care is important, as well as being able to do it in underserved settings, or large minority-serving settings. It really is going to be about thinking, in this whole continuum, of what are the questions, how do we execute the research and then, specifically, who the population is it that we try to go for. These are some of our preliminary thoughts, but in our research agenda, we have different priority areas and health equities are certainly one of them. We are really diving deep into them now.

Q: Where do you see PCORI in the next 10 years?

A: It’s actually pretty simple: we are funded through 2019 and what I would like to see for PCORI is that our contribution to improving patient care and the patient experience is so significant that patients will say, “It can’t go away.” What I really envision is that PCORI becomes a go-to place for patients and, frankly, even for their providers. We are willing to be really innovative and we’re willing to be very open. So, whether it’s creating new apps, or thinking about a webpage or a YouTube channel, nothing is off the table. Obviously, doing our work and publishing it in the New England Journal of Medicine is not the way to get to patients, so we are going to have to think very creatively about how [to] make [our] work relevant for patients.

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Building Health Reform’s Research Arm

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